The present invention is directed generally to a transpyloric jejunostomy cannulating apparatus and method to enable an operating surgeon to safely and rapidly cannulate the jejunum via a Stamm gastrostomy.
A reaction to major surgery is that stomach function may be impaired for up to ten days. On the other hand, the body needs to absorb nutrition immediately after surgery in order to promote healing. Furthermore, the nonfunctioning unfed gut can become a source of bacteria that gets into the blood stream. These problems are resolved by the introduction of nutrients through a jejunal tube properly inserted through the abdominal wall, gastric wall, pylorus and duodenum of a patient, into the jejunum beyond the ligament of Treitz.
Transpyloric passage of a jejunal tube is technically difficult to achieve because of at least the following anatomic problems. First, the pylorus and duodenum are in the retroperitoneum covered by small bowel mesentery and the right colon, making them poorly accessible to the surgeon's fingers. Secondly, the mucosa of the duodenum is redundant and creates ridges that prevent easy passage of a catheter.
Prior devices are known that are designed to span the pylorus, but all have certain shortcomings. The Moss dual lumen gastrostomy tube, as described in Moss, U.S. Pat. Nos. 4,543,089 and 4,642,092, is intended for transpyloric feeding. However, the tube does not go beyond the duodenum. Since the tip of the Moss tube is situated just beyond the pylorus, nutrients from the tube tend to go back to the stomach rather than moving on to the jejunum. Accordingly, the Moss tube has proved of little benefit to critically ill patients who have had major surgical illness.
The Nyhus-Nelson system is a tube with two balloons that allow the surgeon to do a "push-me/pull-me" technique of passing a tube through the duodenum. This system has the disadvantage of being very time consuming for the surgeon and having a relatively high rate of failure.
Cook Incorporated markets a Carey-Alzate-Coons double lumen gastrojejunostomy set, as described in U.S. Pat. No. 4,581,025 and Re 31,855, wherein the catheter is advanced over a wire guide after insertion of the wire guide through the pylorus and into the duodenum. The Cook device is designed for placement by a radiologist or gastroenterologist with access to an x-ray machine but is not suited for use at the operating table by a surgeon during major abdominal surgery. p Finally, Ross Laboratories produce a gastrostomy tube with an inner cannula that can be pushed through the pylorus by an endoscopist. This system has the disadvantage of requiring endoscopy and is prone to failure because when the endoscope is removed, the tube often comes back with it.
Feeding tubes of the type used in the present invention are marketed by Medical Innovations Corporation and disclosed in U.S. Pat. Nos. 4,685,901 and 4,701,163. The present invention facilitates placement of the feeding tube by a surgeon.
Accordingly, the inventors named herein have developed a transpyloric jejunostomy cannulating system which resolves the shortcomings of the devices described above. The system is based upon initial developments of Martin J. Winkler, M.D. as recorded in Disclosure Document No. 255713 received in the Patent and Trademark Office on Jun. 20, 1990 and in Disclosure Document No. 256401 received in the Patent and Trademark Office on Jun. 25, 1990.
A primary objective of the invention is to provide rapid, clean and atraumatic passage of a transpyloric jejuno-gastrostomy catheter from the skin through the abdominal wall, through the gastric wall, through the pylorus and duodenum, into the jejunum beyond the ligament of Treitz.
Another objective is to provide early nutritional support and calories for a traumatized patient immediately following surgery.
Another objective is to provide a transpyloric jejunostomy cannulating system which enables a feeding tube to be placed quickly for the sake of both the patient and doctor.
Another objective is to provide atraumatic insertion of a jejunal feeding tube with a minimum loss of blood.
A further objective of the invention is to provide a transpyloric jejunostomy cannulating system which provides for aspirating the stomach contents to prevent stomach fluid from contaminating the peritoneal cavity at the time the tube is placed by the surgeon
Finally, an objective of the invention is to provide a transpyloric jejunostomy cannulating system based upon a combination of simple and rugged devices which are economical to manufacture and which are efficient in operation.